Pregnant immigrants say they are denied prenatal care from Joburg clinics, despite Constitutional Court order

Priscilla Tumira from Zimbabwe thinks she is eight months pregnant, but she has not had any prenatal health care. Without valid documents, Tumira says, staff at Jeppe and Hillbrow Clinics in Johannesburg refused her registration for prenatal care.

“Our people no longer have enough medical resources, you must go back and give birth in your countries,” she says she was told by a nurse at Jeppe Clinic when she arrived without a residence permit or proof of residence.

In April the Gauteng high court ruled that pregnant women and children under six years old must have access to free public health services irrespective of nationality and documentation status. This followed an application brought by Setion27 alongside women who had been denied access. The Court ordered that regulations and a policy introduced by the Gauteng Department of Health in 2020, that denies free health care services to pregnant and breastfeeding women and young children who are asylum seekers, undocumented, or persons affected by statelessness are declared unlawful. The Gauteng Department of Health was ordered to amend its policy by 16 October 2023. The court said any such policies or circulars are inconsistent with the National Health Act and are invalid.

Read more in Daily Maverick: High court upholds right of pregnant women, young children to free health services — regardless of documentation status

But Tumira says she has been to both the Jeppe and Hillbrow clinics since the ruling and has again been turned away.

She is one of many pregnant immigrant women from countries like Zimbabwe, Mozambique, Lesotho, Malawi and the Democratic Republic of Congo who are struggling to register for prenatal care. Some have no documents at all, others are asylum seekers and refugees who have been struggling to renew their documents. Some end up giving birth at home, risking both the mother and the baby’s lives.

Tumira says her husband does not have full-time work and she cannot afford private health care. She just hopes all will go well.

“Whenever my baby kicks, I take it as a sign that the baby must be doing all right … although I can’t know for sure without going to the clinic.”

Several immigrant women GroundUp spoke to reported similar experiences. Some who have no documents have resorted to buying fake asylum permits and proof of residency documents, paying anything between R300 and R400 to have a chance to register for prenatal care. The prices of fake asylum permits vary according to how far advanced the pregnancy is. But this does not guarantee acceptance as some clinic staff now have a way of detecting that the documents are fake.

Sometimes the dealers take advantage of the women’s desperation by raising prices, Ellen Cihuri, from Malawi, who is also pregnant, said.

She paid R400 for a fake asylum and proof of residence, but she says clinic staff at Jeppe clinic turned her away in March and again in April after noticing the documents were fake. She too is almost due for delivery and has not registered.

Some women said they were asked to pay bribes to clinic staff at Jeppe and Hillbrow clinic to register without valid documents, and were refused registration if they failed to pay. In some cases, women with high-risk pregnancies were referred to hospitals such as Johannesburg General, Steve Biko Academic Hospital and Tshwane Hospital, and asked to pay lump sums of money upfront and being turned away if they failed to pay.

“What we are faced with is an institutional problem within the Department of Health where health staff are the very people chasing undocumented and vulnerable pregnant women from registering at clinics and making xenophobic remarks,” said Ethel Musonza of the Zimbabwe Isolated Women in South Africa (Ziwisa).

She said this year the organisation has been approached by about 30 women, mostly from Malawi and Zimbabwe, who were struggling to register at clinics. Some have since given birth at home, like Beritta Sibanda from Bulawayo.

Her asylum permit expired about five years ago and she was denied access to prenatal care at Jeppe, Hillbrow and Coronation Clinic in August and October 2022. Her four-month-old baby was born prematurely, while she was alone at home in December 2023. The little boy is still underweight, she says.

“It was a nightmare. I was vulnerable and needed to be in a proper maternity ward,” Sibanda said.

Mbali Baduza, legal researcher at Section27, says denial of health care is a violation of the Constitution.

“Section 27(1)(a) of the Constitution states that ‘everyone has the right to access healthcare services, including reproductive health care’. The term ‘everyone’ has been explicitly interpreted by our courts to include foreign nationals.”

National Department of Health spokesperson for Johannesburg Foster Mogale said the department had not received any formal complaints from women who had been denied treatment at any of these clinics in Gauteng. He urged people to lodge formal complaints. Health workers found to have violated patients’ rights would be “dealt with,” he said

High maternity fees

In Pretoria, some immigrants from Democratic Republic of Congo whose asylum documents had expired were registered by Doctors without Borders in Marabastad. They had been refused care at Skinner Clinic and Sammy Marks. With their registration cards they were able to attend public clinics and be referred to Steve Biko and Tshwane hospitals to deliver.

But in some cases, hospital staff told them they would have to pay R10,000 for a normal birth and R30,000 for a caesarean birth, and that it was a requirement for foreign nationals to pay at least half upfront.

“They say we are foreigners and must go and give birth in our own countries. They want us to pay even if we do not have the money,” said Bibiche Lotika, whose baby is now a month old. She owes Steve Biko hospital money after having a C-section in April.

Faraji Lotika’s baby is less than a month old. She was asked to pay R10,000 at Tshwane Hospital in April and when she failed to pay she was refused the baby’s birth records, she says.

Mogale said services at clinics and community health centres were free but both South African and foreign patients had to pay for higher levels of care in hospitals. He said everyone except refugees with valid documents (refugees status permit) had to pay or sign a debt acknowledgment form.

“The department has a policy called the Uniform Patient Fees Schedule which determines what fees and at what level of care these should be paid.

“No patient should be denied treatment because they do not have money, especially emergency patients,” he said.

On whether the Department would comply with the recent judgment, Mogale said the Department was still studying the court judgment and would make an announcement on the next step. DM

This reporting was supported by the International Women’s Media Foundation’s Howard G Buffett Fund for Women Journalists.

First published by GroundUp.